Over the past few months, patients and health-care providers have been encouraged to pledge to improve compassionate quality care in Ontario as part of a movement called Change Day Ontario.

Nearly 6,000 voices have made pledges on the site and through social media. They range from the individual to the institutional, from those geared towards better understanding the patient perspective to actively combating systemic discrimination on a hospital ward, from promoting safe and effective use of technology to improving equitable access to mental health and addiction services.

One pledge promised to “always demonstrate high quality and safe care through positive patient identification every patient, every time.”

TanishqSuryavanshi

As debates peak about the future of our health-care system, and as health-care technology evolves rapidly, initiatives like Change Day Ontario are important in fostering a culture of change at the front lines.

Yet despite the enthusiasm of its supporters, Change Day is not without its critics. Some question the effectiveness of the pledges and whether they will produce tangible benefits. Others speak to the difficulties individuals face trying to achieve change and emphasize the need for institutions to facilitate pledges from the front line.

But the true value of Change Day runs much deeper than the individual pledges.

The first Change Day was sparked by the sense of disempowerment and frustration workers felt in England’s National Health Service (NHS). The NHS’s top-down approach to improvement created frustration among the front-line workers and bred pessimism about reform. So junior doctors reached out to senior leadership through Twitter to emphasize the need for system-wide leadership in health-care improvement.

MichaelParvizian

The resultant Change Day helped to foster a culture of change by empowering workers to solve daily problems. Promoting change as a necessary part of a complex system, and providing avenues to do so, is what makes initiatives like Change Day so important.

Change Day was brought to Ontario this year by Associated Medical Services and Health Quality Ontario.

Similar to the NHS, Ontario struggles when it comes to achieving change. A lack of unified vision and principles due to complex bureaucracy and fragmented accountability have left us without a culture that embraces continuous improvement and quality care.

In addition to this aversion to change, Ontario’s health-care system is navigating complex challenges. Rising costs, political tensions and increased demands are straining stakeholders across the system, and bringing the sustainability of the system into question. Promising new technologies are being explored, but disruptive technologies and rapid systemic reform are not always compatible with a system averse to change.

A well-known aphorism in management states that “corporate culture eats strategy for breakfast.” Strategies to implement large innovative solutions in a system unable to adapt to change are ineffective, since solutions are likely to be rejected at the front line. Unless the value of change is demonstrated and emphasized as a normal part of day-to-day work, well-intentioned initiatives will have difficulty solving problems in Ontario.

Bringing Change Day to Ontario provides value in the way it influences the culture of our system. Inspiring workers to question how they do things, and encouraging them to try something new, sends an important message.

This change in culture is a step in the right direction. But more than just Change Day is required to convince health-care stakeholders that Ontario truly values this message.

Institutions such as hospitals, universities and government must ensure the message carries on, rather than reverting to the status quo.

Solidifying this culture of change will help create an adaptable health-care system in Ontario. This adaptability is key to addressing the strains on the system and accommodating disruptive new technologies to positively transform care.

Tanishq Suryavanshi is a medical student at McMaster University and a contributor to EvidenceNetwork.ca. He is a co-leader of the Rapid Response Team at the Ontario Medical Students Association (OMSA) and is a researcher with the Global Strategy Lab at U Ottawa and York U. Michael K. Parvizian is a first-year medical student at McMaster University, with interests in health policy and resource utilization. He is a member of the Rapid Response Team at the OMSA, and a current Queen Elizabeth Scholar in Health Systems research.

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